tbuckley/cabot-search huggingface dataset:
CD10 (P75) Are ‘hypoallergenic’ personal care products truly safe?
Authors: Siwaporn Hiranput, Lucy Smith, Paul Devakar Yesudian
Journal: British Journal of Dermatology (2023)

Abstract It is estimated that one-fifth of the general population may have allergic contact dermatitis (ACD) to common environmental allergens. Skincare companies are increasingly advertising their products as ‘hypoallergenic’, targeting consumers who seek personal care products (PCPs) that are less likely to cause an allergic reaction. However, there are no Food and Drug Administration standards to regulate the use of the term hypoallergenic, allowing manufacturers to use the term freely. We evaluated PCPs marketed as hypoallergenic from two health and beauty retailers in the UK for the presence of allergens in the British Society of Cutaneous Allergy (BSCA) baseline series. Product and ingredient lists were obtained from www.boots.com and www.superdrug.com in November 2022 using the term hypoallergenic in the search box. PCPs without the term hypoallergenic in the product description, unrelated products (plasters, jewellery, sanitary towels, tampons, clothing and facial brushes) and duplicates (same products in different sizes) were excluded. In total, 208 PCPs met the inclusion criteria: 47 (22.6%) were rinse-off and 161 (77.4%) were leave-on products. At least one substance from the BSCA baseline series was an ingredient in 79 (38.0%) PCPs. Of these, 54 (26.0%) had one potential allergen, 21 (10.2%) had two, and four (1.9%) had three potential allergens from the series. The frequently encountered allergens were cetearyl alcohol and paraben mix, found in 42 (20.4%) and 37 (18.0%) of products, respectively. Other BSCA baseline series allergens identified in PCPs included 2-bromo-2-nitropropane-1,3-diol, lanolin, decyl glucoside, diazolidinyl urea, methylisothiazolinone, limonene and linalool. In addition, PCPs had chemicals that were related to and may cross-react with allergens in the BSCA baseline series. Parfum/fragrance, which can crossreact with fragrance mix I and II, was found in 85 (41.3%) PCPs. Sodium benzoate and/or benzoic acid, often used as preservatives in PCPs, were found in 66 (32.0%) products. Forty (19.4%) PCPs had ingredients that belong to the Asteraceae family and therefore may trigger an ACD in those with positive reaction to Compositae and/or sesquiterpene lactone mix. Twenty-three (11.2%) PCPs contained cetyl alcohol and/or stearyl alcohol, the two major components of cetearyl alcohol. Overall, 153 (74.3%) of 206 PCPs marketed as hypoallergenic contained BSCA baseline series allergens or ingredients that may cross-react with them. This highlights the need to increase public awareness and education about the potential dangers of purchasing ‘hypoallergenic’ PCPs.
P103 A retrospective observational study of toxic epidermal necrolysis at a tertiary referral centre from 2015 to 2022
Authors: Nicola Watson, Katie Best, Simon Meggitt, Phil Hampton
Journal: British Journal of Dermatology (2023)

Abstract Toxic epidermal necrolysis (TEN) is associated with high mortality and morbidity. Owing to a lack of robust evidence, treatment guidelines are ambiguous and clinicians must use discretion in management decisions, specifically with regard to the use and choice of systemic agents, including immunosuppressants. We present a retrospective study of cases referred to a tertiary referral centre between 2015 and 2022. Cases were identified using histopathology coding and a database compiled by clinicians. Forty cases were categorized as follows: TEN (n = 12); Stevens–Johnson syndrome (SJS)/TEN overlap (n = 5); SJS (n = 5); unclear (n = 9); insufficient information (n = 5) and others [n = 9 (lupus, n = 4; erythema multiforme major, n = 3; burn, n = 1; recurrent erythema multiforme, n = 1)]. The median age of patients with TEN was 66 [interquartile range (IQR) 53.3–74; 33% men, 67% women]. The median percentage body surface area of epidermal loss was 40% (n = 8; IQR 30–70). Forty-two per cent of patients had an underlying malignancy. Implicated medications included nivolumab/ipilimumab (n = 2), co-trimoxazole (n = 2), carbamazepine (n = 1) and proton pump inhibitors (n = 3). Sixty-seven per cent of patients with TEN were managed by the burns centre, with a further 17% admitted to the intensive care unit. One patient presented directly to the dermatology team and 58% were transferred from other hospitals. The median time from the documented onset of rash to transfer to specialist care was 5 days (IQR 2.8–11.5). Thirty-three per cent of patients were given immunosuppression (intravenous methylprednisolone). The median duration of admission was 14 days (IQR 7.5–21.5). Fifty-eight per cent of patients (n = 7) survived. None of the five patients who died had received immunosuppression. The median time from onset of rash to receiving specialist care was 3.5 days for those who survived (n = 4) vs. 10 days for those who did not (n = 3; P = 0.03). Thirty-three per cent of patients had documented chronic complications (severe ophthalmic sequelae, n = 2; circumcision for phimosis, n = 1). This study was limited by the retrospective collection of data and the method used to identify cases. The current evidence for the treatment of TEN is primarily derived from small case series that often combine heterogeneous cases of TEN, SJS/TEN overlap and SJS. This is highly problematic as the risk–benefit dynamic varies greatly between patients with SJS, who have an excellent prognosis without treatment, and patients with TEN with a high associated mortality, who potentially have more to gain from immunosuppression. Our data support the need for patients to access specialist care promptly, to allow for early consideration of immunosuppression. Future research should focus on effective treatments for reducing mortality in cases of TEN specifically.
BT07 Creation of a skin lesion image pipeline: key steps in developing a mobile application with DICOM® fields and metadata
Authors: Gillian X M Chin, Andrew Coon, Chris Wilde, Shareen Muthiah, Colin Morton, Colin Fleming
Journal: British Journal of Dermatology (2023)

Abstract A key issue facing artificial intelligence (AI) for dermatology is the lack of standardization around capture, transfer and storage of skin images and clinical data. To assist systematic capture of clinical data, we developed a nationally agreed proposed minimum dataset, based on Digital Imaging and Communications in Medicine (DICOM®) standards. Subsequently, we collaborated with an established image management system (IMS) supplier, Waba [supported by grants from our local National Health Service (NHS) innovation department], to incorporate these fields into a dermatology-specific mobile application (app), facilitating real-time capture and data transfer. We describe our steps in developing this app. The app integrates with the national Patient Administration System (SCI Store), allowing retrieval of real-time patient demographics linked to hospital or Community Health Index number. Each care episode captures a standardized dataset, including lesion views, clinical information and consent level. On episode completion, datasets are securely transferred to the IMS via WiFi or GPRS signal, following a fully auditable pathway. The IMS is a web-based app developed on a Microsoft Structured Query Language server, which allows authenticated users to access our trust’s centralized repository of nonradiological images. Adherence to industry-standard data storage format, patient safety reporting and specific access rights ensure compliance with Caldicott recommendations and data protection standards. For AI research, we are exploring conversion of datasets into DICOM format. Close collaboration between software developers and end users, including clinical photography, dermatology and general practice, was essential for app design. We worked on design architecture through fortnightly technical meetings, scheduled to progress development in months 1–8. Installation and functionality testing was performed in months 9 and 10, followed by comprehensive user testing in months 10–12. Live app test-of-change rollout was performed in months 13–16, with continued usability refinement during this period. To develop a standardized minimum dataset, we conducted a consensus exercise with the British Association of Dermatology AI working group. Based on DICOM standards, a comprehensive international standard for medical imaging, this could improve the quality, availability and interoperability of data for AI development. In summary, we have developed an app to standardize the capture, transmission and storage of skin lesion images and associated metadata. By collaborating with an industry partner with NHS experience, iterative user-led design and national engagement for standard-setting, we believe this is a useful step toward a national UK skin database for training and validating AI systems. Future work is planned to evaluate the output of this data pipeline.
DP19 Two patients with Kaposi sarcoma from the 2-week-wait clinic
Authors: Irina Nocivin, Parastoo Babakinejad, Shamali Hoque, Rakesh Anand, Andrew Giles, Steven Morris
Journal: British Journal of Dermatology (2023)

Abstract We present two cases of Kaposi sarcoma (KS) in HIV-negative men who have sex with men (MSM) with no coexisting immunosuppressive treatment or conditions. They both presented with suspicious lesions on lower extremities, with no other mucocutaneous involvement. The initial clinical presentation of both patients was atypical, with uncharacteristic aspects of lesions on clinical examination and dermoscopy, which prompted further investigations. Skin biopsies were performed for both patients. Both cases had similar histological findings in keeping with KS: slit-like vascular spaces within the dermis, proliferation of capillary blood vessels with associated inflammatory infiltrate with lymphocytes and plasma cells and focal aggregates of spindle cells. Immunohistochemistry revealed endothelial cells displaying positive staining for human herpesvirus (HHV)-8. Immunodeficiency screening revealed no abnormalities, and repeat HIV screening was negative in both patients. These cases present an interesting occurrence of an increasingly encountered new subtype of KS seen in HIV-seronegative immunocompetent MSM. In addition to the four established variants of KS, this is an emerging variant that arises mostly in middle-aged MSM. HHV-8 has been identified as the aetiological agent in KS; indeed, the viral infection precedes the development of the disease. The fifth subtype is increasingly recognized: nonepidemic KS in MSM who are HIV-negative and have no other causes for immunodeficiency, as seen in our two cases. This subtype has been reported in the literature since the 1980s in this specific population. The clinical presentation resembles classic KS, with predominantly cutaneous involvement of the lower limbs, running a similar indolent course. There is a strong connection between HHV-8 infection and the development of KS; however, in countries where there is a low prevalence of the virus, in the general population, there is increased detection in the MSM group. Correlating the high detection rate of HHV-8 in MSM with its role in the development in KS, immunocompetent MSM are at risk of developing the condition. However, this subtype carries an overall good prognosis, with an indolent course and good response to similar therapeutic options used in the classic subtype.
BC05 Technological and clinical demonstration of a skin ageing analysis prototype
Authors: Pratyush Pradeep, Mark Birch-Machin, Kirstie Anderson, Jessica Moor
Journal: British Journal of Dermatology (2023)

Abstract The skin undergoes intrinsic and extrinsic ageing, with extrinsic ageing caused by environmental factors including inadequate sleep. Preliminary studies have suggested a link between sleep quality and skin ageing. Noninvasive devices have been developed that are able to measure and quantify markers of skin ageing, such as collagen levels and wrinkle formation. A handheld optical coherence tomography (OCT) test, sourced from Industrial Technology Research Institute, is one such device that allows for the measurement of dermal collagen levels. We describe a pilot study to assess the feasibility of combining several methods to quantify skin ageing in those with and without sleep disturbance, to understand which specific markers of skin ageing are affected by poor sleep. Questionnaires were distributed to 10 female workers and completed by each participant to understand their sleep and sun protection habits. There were two groups: women working fixed day shifts (aged 41–53 years) or fixed night shifts (aged 22–63 years). Skin swabs, VISIA® and OCT were used to measure markers of skin ageing of both cheeks: DNA amplification, wrinkles (percentile) and collagen (percentage), respectively. The entire testing could be completed by each participant within 15 minutes. The results were then compared between the different groups. The testing was well tolerated in this small sample. There was a statistically significant difference between day and night workers in their percentile of wrinkles using the VISIA (left cheek: P = 0.039; right cheek: P = 0.015), with night workers showing fewer signs of wrinkle formation. No statistically significant difference in DNA amplification was observed between day and night workers using skin swabs (left cheek: P = 0.27; right cheek: P = 0.32). Using OCT, no statistically significant difference was observed in collagen percentage between day and night workers (left cheek: P = 0.73; right cheek: P = 0.98). Skin swabs, OCT and VISIA were well tolerated, with no adverse events seen. The VISIA showed a significant difference in markers of skin ageing between day and night workers. Night shift workers may have shown fewer signs of wrinkle formation due to confounding factors such as age and smoking. No significant difference was observed with skin swabs and OCT, which may be related to the small sample size. The skin swabs, VISIA and OCT together can be quickly used to test the impact of sleep or any other extrinsic factor on skin ageing. This study has provided useful pilot data that can be scaled for future, larger studies.
DS23 Efficiency and performance of slide stainers during Mohs frozen section processing
Authors: Brogan Kelly Salence, Mohammad Shams, Peter Sounthararajah, Raj Mallipeddi
Journal: British Journal of Dermatology (2023)

Abstract Mohs micrographic surgery (MMS) relies on good-quality, well-stained frozen sections for effective histological analysis. Slides should also be produced as quickly as possible. Automation of complementary devices in the laboratory ensures standardization and efficiency and improves the overall quality of performance. Our study evaluated the efficiency and performance of the Autostainer-XL (Leica) vs. the Linistat (Thermo Scientific) slide stainer within a busy MMS unit. The Autostainer-XL rapidly dries, loads and unloads slides automatically allowing the Mohs-trained biomedical scientist (BMS) to work in parallel on cryotomy. The Autostainer-XL stains slides with haematoxylin and eosin within 10 min and 50 s. In comparison, the Linistat was much slower and required the Mohs-trained BMS to fix the slides manually on a hotplate, place them in industrial methylated spirit, wash them in water and load individual slides into the Linistat, taking 16 min and 45 s to complete the staining process. Two blinded assessors retrospectively reviewed the same set of 50 Linistat-stained and 50 Autostainer-XL stained frozen section slides for consistency in staining. The scoring criteria were based on the modified UK National External Quality Assessment Service (NEQAS) Cellular Pathology Technique Mohs scheme assessment criteria. Each assessor allocated scores between 1 and 5 based on the scoring criteria. The mean quality scores were significantly higher for the Autostainer-XL compared with the Linistat (P &amp;lt; 0.05). In our MMS unit, up to 12 patients undergo MMS daily with an average of seven slides required per patient at the first stage, leading to a high processing burden within the Mohs laboratory, particularly at the first stage. The Autostainer-XL increased productivity, with the ability to load 30 slides per rack, while the Linistat was only able to load six slides per rack. In practice, within our MMS unit, the Autostainer-XL reduced the time taken to produce all slides at the first layer by more than 1 h when compared with the Linistat slide stainer. When surveyed, 100% (n = 8/8) of Mohs-trained BMS in the laboratory preferred the Autostainer-XL than the Linistat, with comments suggesting that it was easy to use, quick, precise and an important device that can withstand the demands of a busy Mohs laboratory. The Autostainer-XL offers improved efficiency and performance, with reduced staining times, an ability to process a larger number of slides and fully customisable automation when compared with the Linistat (Thermo Scientific) slide stainer.
DS15 Metastatic cutaneous squamous cell carcinoma: how best to develop a skin cancer service for future populations
Authors: Siobhan Rafferty, Alicia Goh, Laoise Griffin, Emma Tierney, Kashif Ahmad
Journal: British Journal of Dermatology (2023)

Abstract The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing in the White population. Despite a favourable prognosis in the majority, it remains a cause of morbidity and mortality, especially in immunosuppressed and elderly individuals. Large cSCCs can be challenging for surgical clearance, recurrence and metastatic disease, despite guidelines for the management and staging of cSCC. We sought to identify high-risk features of those who develop metastatic disease. Our centre typically manages 300 cSCCs annually, but only cSCCs discussed at our two multidisciplinary team (MDT) meetings (head and neck and skin cancer) at our level 4 hospital over a 3-year period (2019–2021) were included in a retrospective observational study. A total of 124 patients with high-risk cSCC (due to patient or tumour factors) were included. Male sex predominated. Sixteen cases had metastatic disease. Median age at diagnosis was 80 years in the total MDT group and 86.5 years in the metastasis group. Of 16 patients with metastases, eight had complete primary excisions. Five cases had incomplete primary excision (peripheral or deep margins involved), and three cases had a narrow margin of &amp;lt; 1 mm. Primary tumour size was similar in both the MDT and metastasis groups (median size 17 vs. 20 mm). Head and neck sites predominated in both (88%). In the metastatic group, one had chronic lymphocytic leukaemia, but no other patients with immunosuppression were identified, and the majority (81%) suffered with multimorbidity (≥ 2 chronic illnesses). Nine patients with metastatic cSCC received radiotherapy, two systemic chemotherapies, five neck dissections and one immunotherapy. Most patients presenting with metastatic cSCC at our centre were &amp;gt; 85 years old, a group sometimes known as ‘the oldest old’, and many had multimorbidity. This, coupled with tumour location, poses challenges for healthcare professionals in managing the initial cSCC aggressively and implementing a reasonable follow-up and surveillance schedule. In comparing both groups, advanced age was the predominant difference, with twice as many aged &amp;gt; 85 years in the metastasis group vs. the MDT group. Immunosenescence is a process of immune dysfunction that occurs with age and includes remodelling of lymphoid organs, leading to changes in the immune function of the elderly and relates to the development of malignant tumours. It is estimated that 5 million people in the UK will be in this age group by 2050 (www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/health–wellbeing/rb_feb13_understanding_the_oldest_old_improving_later_life.pdf). There is a need to continue to consider this dynamic group (those aged &amp;gt; 85 years) and those with multimorbidity when strategies for the projected management of cSCC are being considered.
PA01 Crusted nodules in returning travellers
Authors: Natalya Fox, Jonathan White, Zainab Jiyad, Leila Ferguson
Journal: British Journal of Dermatology (2023)

Abstract We present the cases of two brothers, aged 10 and 13 years, who, on returning from a 6-week holiday in Sri Lanka, presented to the emergency department with painful, pruritic crusted nodules. Both children were usually fit and well, and up to date with their childhood immunizations; the older brother had a background of mild eczema. On examination, there were multiple widespread 1–2 cm well-defined, superficial excoriated ulcers with overhanding crusted edges. These were present over the arms, legs, back and feet of the younger brother, and the lower legs and feet of the older brother. There was no history of prodromal illness, and they remained afebrile throughout, with no evidence of lymphadenopathy or systemic illness. Bacterial wound swabs demonstrated Corynebacterium diphtheriae. Real-time polymerase chain reaction confirmed the presence of TOX, followed by the Elek test, which demonstrated the expression of the diphtheria toxin, confirming the diagnosis of cutaneous diphtheria due to a toxigenic strain. Both children were treated empirically with intravenous flucloxacillin and clindamycin as inpatients. Both were clinically well and discharged home on oral clindamycin and co-amoxiclav for a total of 10 further days. Public Health was informed of this notifiable disease, with contact tracing and appropriate family screening performed. Our patients isolated appropriately and made a full recovery, with negative swabs. Historically, most cases of diphtheria have been caused by C. diphtheriae (a Gram-positive nonencapsulated, nonsporulating, nonmotile bacillus) with an incubation period of 2–7 days, although other strains, notably Corynebacterium ulcerans, become increasingly prevalent. Despite diphtheria being classically described as a respiratory illness, Public Health England data found that nearly two-thirds of toxigenic C. diphtheriae infections were cutaneous in presentation. Concurrent respiratory infection and cutaneous infection are rare. Either form can be caused by toxigenic or nontoxigenic strains; the former may result in toxic complications (such as myocarditis, polyneuritis, septic arthritis, osteomyelitis and death); however, these are rare in cutaneous diphtheria, even if TOX-positive. Systems review of our patients did not highlight any of these features in our patients. Our patients exemplify classic features of cutaneous diphtheria and raise an important reminder to consider diphtheria in patients returning from endemic areas, despite vaccination schedules being in place.